不同剂量地佐辛对小儿七氟醚复合麻醉苏醒期躁动的影响

目的：评价不同剂量地佐辛对小儿七氟醚复合麻醉苏醒期躁动的影响。方法择期行短小手术的患儿100例，年龄1～3岁，随机分为地佐辛0．03 mg／kg 组（D1组）、0．05 mg／kg 组（D2组）、0．10 mg／kg 组（D3组）和对照组，每组25例。患儿面罩吸入6％的七氟醚，睫毛反射消失后静脉给予瑞芬太尼1μg／kg 置入喉罩，术中吸入1．5％～2．5％七氟醚，并持续静脉输注瑞芬太尼维持麻醉。在手术开始前 D1组、D2组、D3组分别给予地佐辛0．03、0．05和0．10 mg／kg ，对照组给予等容量生理盐水。记录拔除喉罩时间、麻醉恢复室（PACU）停留时间；PACU 期间躁动发生情况，采用患儿麻醉苏醒期躁动量化评分表（PAED）评价躁动程度。患儿入 PACU 即刻（T0）及15 min（T1）、30 min（T2）行 FLACC 评分和 Ramsey 评分。记录术后24 h 患儿不良反应的发生情况。结果与对照组比较，D2组和 D3组躁动发生率、PAED 评分均明显降低（P＜0．05）；D2组和 D3组各时点 FLACC 评分均明显降低（P＜0．05），Ramsey 评分均明显升高（P ＜0．05）。与 D2组比较，D3组 Ramsey 评分明显升高（P ＜0．05）。 D3组PACU 停留时间较其他3组均明显延长（P＜0．05）。结论0．05 mg／kg 及0．10 mg／kg 地佐辛都可以有效减少小儿七氟醚复合麻醉苏醒期躁动的发生，但0．05 mg／kg 地佐辛可减少七氟醚麻醉后苏醒期躁动且镇静强度适当，不延长 PACU 停留时间。

The effect of various doses of dezocine on children emergence agitation after combined sevoflurane general anesthesia

Objective To investigate the effect of various doses of dezocine on the prevention of emergence agitation after sevoflurane anesthesia in children .Methods 100 children aged from 1 to 3 years old were randomly divided into 4 groups with 25 cases each :the 0 .03 mg/kg dezocine group (group D1) ,the 0 .05 mg /kg dezocine group (group D2) ,the 0 .10 mg/kg dezocine group (group D3) and the control group .Anaesthesia was induced with 6% sevoflurane and 1 μg/kg remifentanil .Anaesthesia was maintained with 1 .5% - 2 .5% sevoflurane and remifentanil .Different doses of dezocine 0 .03 mg/kg ,0 .05 mg/kg ,0 .10 mg/kg ,and the same volume saline were administered before surgery .The incidence of emergence agitation was assessed with 5 points scale and the severity of emergence agitation was assessed with Pediatric Anesthesia Emergence Delirium (PAED) scale .The time to remove the laryngeal mask airway ,the time to be discharged from the post-anesthesia care unit (PACU) ,FLACC and Ramsey scores ,post-operative nausea and vomiting were recorded and considered .Results Compared with the control group ,the incidence of emergence agitation and PAED scales of D2 and D3 group were significantly lower than it (P < 0 .05) .Compared with the control group , FLACC scores of D2 and D3 group were lower than it(P< 0 .05) .At the same time ,Ramsey scores of D2 and D3 were higher than that of the control group(P < 0 .05) .Moreover ,Ramsey score of D3 was higher than D2(P < 0 .05) .The time span of being dis-charged from the PACU of D3 was significantly longer than that of the other groups(P< 0 .05) .Conclusion Dezocine of 0 .05 mg/kg and 0 .10 mg/kg both can reduce the incidence of emergence agitation effectively ,and there is no significant difference between the effect of the two doses .However ,the dose of 0 .05 mg/kg has a better performance in the time span for being discharged from the PACU .